Marge Roukema on Health Care

Former Republican Representative (NJ-5)

Voted NO on allowing suing HMOs, but under federal rules & limited award.

Vote to adopt an amendment that would limit liability and damage awards when a patient is harmed by a denial of health care. It would allow a patient to sue a health maintenance organization in state court but federal, not state, law would govern.

HR 4680, the Medicare Rx 2000 Act, would institute a new program to provide voluntary prescription drug coverage for Medicare beneficiaries through subsidies to private plans. The program would cost an estimated $40 billion over five years and would go into effect in fiscal 2003.

Voted YES on banning physician-assisted suicide.

Vote on HR 2260, the Pain Relief Promotion Act of 1999, would ban the use of drugs for physician-assisted suicide. The bill would not allow doctors to give lethal prescriptions to terminally ill patients, and instead promotes "palliative care," or aggressive pain relief techniques.

Voted YES on establishing tax-exempt Medical Savings Accounts.

The bill allows all taxpayers to create a tax-exempt account for paying medical expenses called a Medical Savings Account [MSA]. Also, the measure would allow the full cost of health care premiums to be taken as a tax deduction for the self-employed and taxpayers who are paying for their own insurance. The bill would also allow the establishment of "HealthMarts," regional groups of insurers, health care providers and employers who could work together to develop packages for uninsured employees. Another provision of the bill would establish "association health plan," in which organizations could combine resources to purchase health insurance at better rates than they could separately.

Limit anti-trust lawsuits on health plans and insurers.

Delineates the relationship between the antitrust laws and negotiations between groups of health care professionals and health plans and health care insurance issuers.

Applies the "rule of reason" standard to negotiations between a health plan and two or more physicians.

Awards attorneys' fees to a substantially prevailing plaintiff only when the defendant's conduct was unreasonable or in bad faith.

Prohibits tying arrangements (linking the participation in one product line to participation in another) between a health plan and health care professional.

Excludes from this Act any negotiations or agreements including Medicare, Medicaid, SCHIP, or other federal programs.

EXCERPTS FROM CONGRESSIONAL FINDINGS:

Congress finds the following:

A large number of Americans receive their health care coverage from managed health care plans.

The market power of insurance companies has increased
tremendously since the early 1990's, due to mergers and acquisitions.

Health plans improperly manipulate the practice of medicine through such mechanisms as inappropriately making medical necessity determinations, and knowingly denying and delaying payment.

The intent of the antitrust laws is to encourage competition and protect the consumer, and the current per se standard for enforcing the antitrust laws in the health care field frequently does not achieve these objectives.

An application of the "rule of reason" will tend to promote both competition and high-quality patient care.

In any action under the antitrust laws challenging a health plan, conduct shall not be deemed illegal per se, but shall be judged on the basis of its reasonableness, taking into account all relevant factors affecting competition and proposed contract terms.

LEGISLATIVE OUTCOME: Referred to the House Committee on the Judiciary; never called for a House vote.

Support telemedicine for underserved areas.

Roukema adopted the Republican Main Street Partnership agenda item:

H.R. 2706, The Medicare Telehealth Validation (MTV) Act. Republican Main Street Partnership members Congressman Doug Ose (CA) and Jo Ann Emerson (MO) have introduced this bill to increase the use of telehealth services under the Medicare program. Currently, telehealth services are restricted to use in certain geographically underserved areas. The MTV Act provides sufficient funding and regulatory relief to expand high technology medical diagnostic tools, across the Internet, to urban as well as rural underserved areas. The bill further provides for expansion of store-and-forward techniques, and for a study of the restrictions on telemedicine due to state licensing rules.

$350 billion for prescriptions for poor seniors.

Roukema adopted the Republican Main Street Partnership agenda item:

Medicare Prescription Drug Benefit One of issues to be addressed this year by Congress is that of providing a prescription drug benefit to our nation's Medicare beneficiaries. Legislation currently being drafted [by Republican Main Street Partnership members] intends to authorize $350 billion over the next 10 years to provide purchasing assistance for prescription medications. The benefit reaches out to low and moderate income seniors by extending coverage to incomes up to 150% of the poverty level. The bill could also include provisions to correct reimbursement reductions for physicians, nurses, hospitals, technicians, home health care providers, and long-term care facilities.

HR933—Osteoporosis Federal Employee Health Benefits Standardization Act of 1999—A bill to ensure that coverage of bone mass measurement is provided under the health benefits program for federal employees (Morella)

HR1187—Medicare Medical Nutrition Therapy Act of 1999—A bill to provide for coverage under part B of the Medicare Program of medical nutrition therapy services furnished by registered dietitians and nutrition professionals. (N. Johnson)

HR2294—Osteoporosis Education and Prevention Act of 1999—A bill to amend the Older Americans Act of 1965 to help prevent osteoporosis. (Berkley/Roukema/DeLauro/Maloney)

HR2471—Public Health Osteoporosis Screening, Diagnosis, and Treatment Act of 1999—A bill to amend the Public Health Service Act to provide for screenings, referrals, and education regarding osteoporosis. (E.B. Johnson/Kelly)

Supported funding Prenatal and Postpartum Care.

The teams of the Women’s Caucus are charged with advancing action on their designated issues in a bipartisan manner. Legislation from Team 3B: Prenatal and Postpartum Care:

HR 1843—Mothers and Newborns Health Insurance Act—improve prenatal care and delivery of healthy babies by enrolling pregnant women under state CHIP programs and allowing the option of automatically enrolling the babies born to those women in CHIP. (Hyde/Lowey)

HR2538—Folic Acid Promotion and Birth Defects Prevention Act—provide for a national folic acid education program to prevent birth defects. 70% of neural tube birth defects could be prevented if women of childbearing age consumed 400 micrograms of folic acid daily. The problem is that a majority of women are still not aware of the benefits of folic acid, nor are they consuming the recommended daily amount. (Roybal-Allard/Emerson)

H. Res. 163—raise awareness of post partum depression. Approximately 400,000 women experience
post partum depression each year. More than just the “baby blues,” the more extreme cases of post partum depression can result in sadness, fatigue, anxiety, irritability, and low self esteem in new mothers. The resolution provides statistics, and provides recommendations on how the US can work to reduce its incidence, including providing information, training of medical providers, and screening of new mothers for symptoms for early detection of the problem. Additionally, the resolution calls on the U.S. to begin to collect data on post partum depression, so that we can measure its extent. (Capps-Kingston)

HR1848—Right to Breastfeed Act—ensure a woman’s right to breastfeed her child on any part of federal property (federal parks, federal buildings, and national museums) where she and her child have a right to be. (Maloney/Morella/Roybal-Allard) [STATUS: enacted as part of the FY2000 Treasury-Postal Appropriations bill]

HR 1636—Teen Pregnancy Reduction Act—The federal government spends more than $200 million annually specifically for teen pregnancy programs or services. These amounts demonstrate a significant investment in a national effort to prevent teen pregnancy. However, we know very little about the effectiveness of teen pregnancy prevention programs because adequate evaluation is not taking place. In an effort to bolster evaluation of teen pregnancy prevention programs of every type, the bill would provide for both a substantial
investment in rigorous, scientific evaluation as well as the dissemination of information on programs, models and processes that have proven effective in preventing teen pregnancy. (Lowey/Castle)

HR 827—Improved Maternal and Children’s Health Coverage Act of 1999—expand health coverage for uninsured children by improving the outreach to an enrollment of children into Medicaid and the State Children’s Health Insurance Program (S-CHIP). (DeGette)

HR 1085—Healthy Kids Act 2000—improve health care for pregnant women and newborns by ensuring direct access to obstetric and gynecological care for women and pediatric care for children, by giving states greater flexibility by allowing them to enroll income-eligible pregnant women in State Children’s Health Insurance Program (CHIP) and by increasing enrollment of Medicaid-eligible women. This bill also includes sections for pediatric medical education, public health promotion, and research. (Emerson)